Rarely, rheumatic heart disease (RHD) involves all the four valves and causes could be rheumatic, congenital, infective, or degenerative. Here, we report a case of a 42-year-old female known case RHD for 30 years and underwent closed mitral commissurotomy 25 years back presented with progressive exertional dyspnea for the past 1 year. On clinical examination, she was in atrial fibrillation with evidence of the involvement of the mitral, aortic, and tricuspid valves. Transthoracic echocardiography showed the quadrivalvular involvement including pulmonary valves. Only few case reports are available describing rheumatic quadrivalvular damage.